The role of shear wave elastography in the assessment of carotid plaque vulnerability: a systematic review and meta-analysis.

Abstract

Introduction: Stroke is the second most common cause of death and disability worldwide. The correlation between plaque vulnerability and stroke risk needs to be further determined. Shear wave elastography is a promising, non-invasive, low-cost tool for carotid plaques vulnerability assessment. We examined the role of quantification of the carotid plaque's composition using shear wave elastography (SWE) and the subsequent classification of the plaque as symptomatic (in patients who have had stroke/TIA attributed to the plaque) or asymptomatic, and likewise as vulnerable (having features that predispose to stroke, such as lipid-rich necrotic core or hemorrhage) or stable.

Evidence acquisition: A systematic review and meta-analysis were conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Databases Medline (PubMed), Scopus, Cochrane Library and ClinicalTrials.gov were searched from inception to July 2024. The primary goal was to evaluate SWE as a diagnostic tool for vulnerable carotid plaques.

Evidence synthesis: The search resulted in the identification of 606 studies, of which 24 specifically examined our primary objective. Five comparative studies were included in the symptomatic vs. asymptomatic group of the meta-analysis, while three were included in the vulnerable vs. stable group. For symptomatic vs. asymptomatic plaques analysis the pooled Standardized Mean Difference (SMD) is -0.89 with a 95% confidence interval (CI) of [-1.28, -0.50], while for vulnerable vs. stable plaques analysis the pooled SMD -2.38 with a 95% CI of [-3.68, -1.07]. Symptomatic and vulnerable carotid plaques showcased significantly lower Young's modulus (kPa) values (both, P<0.001).

Conclusions: SWE has shown promising results for carotid plaque assessment and stroke risk stratification. Further prospective multicenter clinical studies are needed to determine optimal techniques and parameters for Young's modulus and shear wave velocity indexes, enhancing stroke prevention and treatment.